workforce incentive program – doctor stream …content... · there are two payment systems used...

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WORKFORCE INCENTIVE PROGRAM – DOCTOR STREAM

FLEXIBLE PAYMENT SYSTEM

APPLICATION FORM Note: includes approved GP training and Central Payment System top-ups

Effective Date: 1 January 2020

Please note this application form requires handwritten signatures and therefore is intended to be paper based. The Printable PDF version is the recommended document for medical practitioners to download, print,

complete and submit.

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PART 1 – INFORMATION REGARDING THE FPS FOR THE WIP – DOCTOR STREAM The Workforce Incentive Program (WIP) – Doctor Stream aims to encourage medical practitioners to practise in regional, rural and remote communities and promote careers in rural medicine through the provision of financial incentives.

There are two payment systems used for the WIP – Doctor Stream:

• The Central Payment System (CPS) applies to medical practitioners who bill the Medicare Benefits Schedule (MBS) for eligible services at or above $6,000 per quarter. These medical practitioners will have their eligibility automatically assessed each quarter and will be advised and paid by Services Australia when a payment is due.

• The Flexible Payment System (FPS) applies to medical practitioners who provide eligible non-Medicare services and/or undertake training on approved pathways that is not reflected in MBS records.

This application form relates only to the FPS. This may include practitioners who have already received a CPS payment and are applying for a top-up payment or who have completed a mix of CPS and FPS quarters. Applications for payments under the FPS are assessed by Rural Workforce Agencies (RWAs) in each state and the Northern Territory. RWAs are responsible for administering the FPS based on the WIP Guidelines. Submission of an FPS application acknowledges that the applicant has read and understood the WIP Guidelines. The Australian Government is not liable for payments in relation to applications made on the basis of incorrect advice provided by RWAs. FPS Payments are processed by Services Australia, who will notify the medical practitioner in writing of the payment amount.

To apply for a payment under the FPS, complete and submit this application form to the RWA in the state or Northern Territory in which you provided the majority of eligible services. If you have any questions regarding your eligibility or how to fill out any part of this form, please contact your RWA (See the Submitting an application section for contact details).

Medical practitioners participating in Health Care Homes – For medical practitioners who require assessment under the FPS for other eligible non-Medicare services, this application process will capture Health Care Homes activity, i.e. you do not need to complete a WIP – Doctor Stream: Health Care Homes review form.

Medical practitioners who DO NOT require assessment under the FPS for other eligible non-Medicare services and believe their WIP – Doctor Stream payment has been affected by their participation in Health Care Homes should complete a WIP – Doctor Stream: Health Care Homes review form, available on the Department of Health website.

https://www1.health.gov.au/internet/main/publishing.nsf/Content/workforce-incentive-program-doctor-stream-hch

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Eligibility To be eligible for the WIP – Doctor Stream, medical practitioners must:

• provide a minimum amount of eligible primary care services in eligible locations and/or undertake eligible general practice (GP) training under an approved training pathway; and

• meet the required number of active quarters for payment; and

• have an eligible current Medicare provider number; and

• have provided current bank account details to Services Australia specifically for the WIP – Doctor Stream (or have previously provided these details for the General Practice Rural Incentives Program).

Medical practitioners accessing WIP – Doctor Stream for incentive payments are assessed based on:

• the amount of eligible services provided within a payment quarter period;

• the Modified Monash (MM) classification of the location in which eligible services are provided; and

• duration of active service within the program.

Payments are determined by activity within quarters.

Quarter One – July, August, September Quarter Two – October, November, December Quarter Three – January, February, March Quarter Four – April, May, June For more information about eligibility, please refer to the WIP Guidelines available at www.health.gov.au/workforceincentiveprogram.

WIP – Doctor Stream Sessions Activity in each quarter is captured in ‘sessions’. A session under the FPS refers to an accumulated period of at least three hours in which a medical practitioner provides eligible services (regardless of whether the MBS was billed) and/or undertakes eligible training (see the FPS Provisions section for more information). Sessions can be accumulated over the course of a day and a maximum of TWO sessions can be claimed per day. Sessions can only be claimed for the day the services were provided.

NOTE: PLEASE RECORD ALL TIME SPENT PROVIDING ELIGIBLE SERVICES OR TRAINING OVER THE RELEVANT QUARTERS, REGARDLESS OF WHETHER THE SERVICES WERE MBS BILLED OR YOU HAVE RECEIVED A PAYMENT UNDER THE CPS.

SESSIONS MUST BE IN RELATION TO DIRECT CLINICAL ENGAGEMENT WITH A PATIENT(S).

An active quarter is where a medical practitioner completes at least 21 sessions within MM 3-7 locations in the quarter. This is the minimum quarterly activity threshold for the FPS. A quarter must meet this threshold to count toward a potential payment.

Medical practitioners who complete 104 or more eligible sessions within a quarter meet the threshold condition for maximum payment. This is the maximum quarterly activity threshold for the FPS.

Medical practitioners who are billing the MBS for some services and meet the threshold to trigger a CPS payment, but who also have other eligible non-Medicare services to claim under the FPS, can apply through the FPS for a top-up payment. When applying for a top-up payment, medical practitioners will need to account for all eligible activity, including that for which a CPS payment may have been generated.

http://www.health.gov.au/workforceincentiveprogram

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FPS Provisions

To be eligible, medical practitioners must provide eligible non-Medicare services and/or undertake eligible training (See the Eligible GP Training Placements section for more information) in eligible regional, rural and remote locations in Australia through the Alternative employment or Special Top-Up provisions outlined in the tables below.

All eligible services are required to be in relation to direct clinical engagement with a patient(s) and Special Top-Up services must be provided by the medical practitioner to the patient(s) physically within the eligible location category.

Location Alternative Employment MM 3-7 Medical practitioners working for:

• Aboriginal Medical Services (AMS); or • the Royal Flying Doctor Service (RFDS) based in MM 3-7 for all eligible primary care

services; or Participants on approved training pathways* in eligible GP training placements who are not billing the MBS sufficiently to reflect the services they have provided.

MM 6-7 Commonwealth or State salaried medical practitioners providing primary care services.

MM 1-2 Participants on approved training pathways undertaking approved advanced training in MM 1-2 locations regardless of their MBS billing levels**. RFDS based in MM 1-2 are eligible to apply only for primary care services delivered in association with an overnight stay in MM 3-7 (either before or after).

*Refer to Eligible GP Training Placements section for approved pathways.

**Note: MM 1 and MM 2 locations only include selected GP training placements. (See the Eligible GP Training Placements section for more information.)

Location Special Top-Up Provisions (Only where the minimum quarterly threshold has been met for eligible clinical services in all quarters)

MM 6-7 Medical practitioners who undertake: • excessive travel time* to provide outreach services; • population health work in Aboriginal and Torres Strait Islander communities;

or • support to Aboriginal and Torres Strait Islander health workers and/or Aboriginal and Torres

Strait Islander health practitioners.

*Note: Excessive travel time is considered as three or more cumulative hours per week above an initial 3 hours per week threshold. Travel time must be from the practice location in MM 6-7 in which the medical practitioner is based, to the location in which they are providing outreach services in MM 6-7 (and back). Travel from locations in MM 3-5 to outreach locations in MM 6-7 may be considered where the base location is the nearest reasonable health service. Travel time must be claimed as sessions of a minimum of three hours and are included in the TWO sessions per day limit.

Excessive travel provisions apply to eligible primary care sessions provided by the RFDS in MM 6-7 locations however may be delivered from base locations in MM 3-5. RFDS practitioners based in MM 1-2 may also apply for excessive travel where eligible primary care sessions are claimed in association with an overnight stay (in MM 6-7).

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Eligible Locations

Eligible locations are those in Australia within MM 3-7 classifications of the Modified Monash Model (MMM). Eligible services are based on the practice or outreach location, regardless of medical practitioner or patient address. In order to be eligible for Alternative Employment or Special Top-Up provisions, services or training must be in the relevant location category listed in the Alternative Employment and Special Top-Up Provisions tables. The MM classification of a location can be checked using the Health Workforce Locator on the DoctorConnect website.

Eligible GP Training Placements

Participants undertaking approved GP training placements are eligible to apply for payment under the FPS, where MBS records do not reflect their services/training. The following are approved training pathways for the purposes of the WIP – Doctor Stream:

• Australian General Practice Training (AGPT) Program; • Australian College of Rural and Remote Medicine (ACRRM) Independent Pathway; • Remote Vocational Training Scheme (RVTS); and • Royal Australian College of General Practitioners (RACGP) Practice Experience Program (PEP).

Eligible training placements are those located in Australia within MM 3-7 classifications. Selected training placements in MM 1-2 locations may be eligible. Only AGPT GP Registrars on the rural pathway completing relevant training placements in MM 1-2 locations (Advanced Rural Skills Training or Advanced Specialised Training) are eligible for incentives if the training is authorised by their Regional Training Organisation (RTO). Eligibility for participants on other pathways will be considered on a case-by-case basis.

Eligible training placements do not include the compulsory hospital year required by the RACGP or core clinical training year required by the ACRRM. All other GP training undertaken in hospitals on approved pathways in MM 3-7 locations is eligible.

Application timeframes: When Should I Apply?

In the following application form you will need to cover a period of between four and eight active quarters to be eligible for a payment (active quarters may include exclusively MBS billed quarters and/or quarters that are a mix of MBS and non-MBS billed eligible activity. Eligible MBS billed activity need NOT have been conducted under Alternative Employment provisions). Please attach additional pages if required. If you would like to determine the period appropriate to your particular circumstances, please contact your RWA. All practitioners are encouraged to submit their applications as soon as practicable following completion of the required amount of quarters for payment.

Practitioners who have not received a CPS payment

All continuing participants, as well as new participants to the program billing predominantly in MM 6-7 locations (≥50%), will become eligible for a payment once they have completed four active quarters within an eight quarter period. These applications will only be assessed on a period of up to eight quarters prior to the quarter in which the application is received by the RWA. This means that medical practitioners are only allowed to claim retrospective payment/s dating back two years from the quarter their application is received by their RWA.

New participants to the program billing predominantly in MM 3-5 locations (>50%) will become eligible for a payment once they have completed eight active quarters within a 16 quarter period. These applications will only be assessed on a period of up to 16 quarters prior to the quarter in which the application is received by the RWA. This means that medical practitioners are only allowed to claim retrospective payment/s dating back four years from the quarter their application is received by their RWA.

Practitioners applying for a ‘top-up’ of their CPS payment

If a medical practitioner has billed Medicare enough to meet the threshold and receive a payment under the CPS but has done extra eligible work over that payment period that was not captured in Medicare billing, they will have six months from the date of the CPS payment advice letter to submit an FPS Application Form that captures all time spent providing all eligible services related to that payment period.

http://www.health.gov.au/doctorconnect

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What Do I Need to Include with My Application?

All applications for Alternative Employment and Special Top-Up Provision incentive payments will require sufficient supporting documentation to confirm the information recorded on the application form. (See the Supporting Documentation section for more information.) A standard template showing the details required in a letter from a medical practitioner’s employer/practice manager can be found at the end of this form.

Submitting an application

Please submit your application to the RWA in the state or territory where you provide the majority of eligible services.

State/Territory Name Contact Email Contact Number

Northern Territory Northern Territory Primary Health Network

[email protected] (08) 8982 1000

South Australia Rural Doctors Workforce Agency South Australia


Western Australia Rural Health West [email protected] (08) 6389 4500

Tasmania HRPlus Tas [email protected] (03) 6332 8600

New South Wales New South Wales Rural Doctors Network


Queensland Health Workforce Queensland


Victoria Rural Workforce Agency Victoria


Further information Further information on the WIP – Doctor Stream and FPS can be found in the WIP Guidelines.

For any queries or assistance related to the FPS, please contact the relevant RWA using the contact details above.

https://www1.health.gov.au/internet/main/publishing.nsf/content/general_practice_rural_incentives_programme-programme-guidelines

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PART 2 – PRE-APPLICATION CHECKLIST ☐Have you provided your current bank account details to Services

Australia for the WIP – Doctor Stream? If not, practitioners can fill in bank details in the relevant section on page 11. Alternatively, medical practitioners can update their bank details securely with Services Australia via Health Professionals Online Services (HPOS) at servicesaustralia.gov.au/hpos or a bank account details form is available on the Services Australia website.

☐Do you fit into one of the Alternate Employment or Special Top-Up Provision categories?

☐Are aware of what period you are able to claim for? Refer to the Application Timeframes section.

☐Have you read and understood all the information in Part 1 of the form?

☐Have you read and understood the WIP Guidelines? Please continue to next page.

https://www.servicesaustralia.gov.au/health-professionals/services/medicare/hpos

https://www.servicesaustralia.gov.au/health-professionals/forms/ip020


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PART 3 – DEFINITIONS OF KEY TERMS Key Term Definition Aboriginal Medical Service An Aboriginal Medical Service is a health service funded principally to provide services

to Aboriginal and Torres Strait Islander individuals. Active Quarters A payment quarter in which a medical practitioner’s activity level is equal to or above the

minimum activity threshold, which under the FPS is 21 sessions per quarter or $6,000 of eligible Medicare billed services.

Approved training pathway The approved training pathways for the purposes of the WIP – Doctor Stream are: • Australian General Practice Training (AGPT) Program; • Australian College of Rural and Remote Medicine (ACRRM) Independent

Pathway; • Remote Vocational Training Scheme (RVTS); and • Royal Australian College of General Practitioners (RACGP) Practice Experience

Program (PEP). Eligible Primary Care Services Eligible primary care services are listed as clinical services from the following sections of

the MBS: Category 1 – Professional attendances Category 2 – Diagnostic procedures and investigations Category 3 – Therapeutic procedures Category 7 – Cleft lip and cleft palate Eligible services do not include diagnostic imaging, pathology services, dentistry, optometry or bulk billing items 10990, 10991 and 10992. Telehealth services within the above categories are generally eligible under the WIP – Doctor Steam with the exception of some specialist items. Eligible telehealth services are based on the medical practitioner’s physical practice location, not the patient location.

Eligible Non-Medicare Services Eligible primary care services under the FPS are broadly equivalent to the eligible primary care services outlined above but are not billed under the Medicare Benefits Schedule (MBS). Eligible ‘Alternative Employment’ and ‘Special Top-Up Provisions’ are the eligible non-Medicare services that attract an incentive payment under the FPS. All eligible services are required to be in relation to direct clinical engagement with a patient(s) and Special Top-Up services must be provided by the medical practitioner to the patient(s) physically within the eligible location category. RFDS patient retrievals or transport are not eligible primary care activities. Note that when applying through the FPS, medical practitioners must apply for all time spent providing WIP – Doctor Stream eligible services, regardless of whether the services were MBS billed.

Eligible Training Participants undertaking GP training on approved training pathways are eligible to apply for payment under the FPS, where MBS records do not fully reflect their services/training. Eligible training placements are those located in Australia within Modified Monash (MM) 3-7 classifications. Selected training placements in MM 1-2 locations may be eligible.

Location Except in the case of RFDS medical practitioners (or similar), for the purposes of this Application Form, location means the town or locality within Australia where eligible services were provided, or where the practice is located. For RFDS medical practitioners, location means the town or locality where the medical practitioner provided eligible services and/or stayed overnight(s) while providing those services.

Modified Monash Model The Modified Monash Model (MMM) is a classification system that categorises metropolitan, regional, rural and remote areas according to both geographical remoteness and population size. The system was developed to recognise the challenges in attracting health workers to more remote and smaller communities. There are seven MM classifications under the MMM. The WIP uses the MMM 2019.

New Participant New participants are medical practitioners who have not previously received incentives under the program, or have not received a payment for activity in the last 24 quarters (six years).

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Payment Quarters Payment Quarters are prescribed time periods below where eligible activity is used to determine if the quarter is active or inactive for a WIP – Doctor Stream payment. Quarter One: July, August, September Quarter Two: October, November, December Quarter Three: January, February, March Quarter Four: April, May, June

Session A session under the FPS refers to an accumulated period of at least three hours in which a medical practitioner provides eligible services (regardless of whether the MBS was billed) and/or undertakes eligible training. Sessions may be accumulated over the course of a day and a maximum of two sessions can be claimed per day. Sessions can only be claimed for the day the services were provided.

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PART 4 – FLEXIBLE PAYMENT SYSTEM – APPLICATION Personal and Contact Details

Title (i.e. Dr)

Given names

Family name

Provider Number (if applicable, list one currently in use)

Primary Practice Name and Address where providing majority of services and/or undertaking majority of GP training

Preferred Mailing Address

If different from above

Mobile phone number

Email address

Please continue to next page.

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Current Bank Account Details Payments will be paid by Electronic Funds Transfer (EFT) into your nominated bank account. Payments cannot be made to credit card, loan or mortgage accounts. Please sign and date in the table below to indicate you have provided accurate current bank account details and that you consent for this information to be forwarded to Services Australia by the RWA in your state or Northern Territory in order to generate payment.

Alternatively, medical practitioners can update their bank details securely with Services Australia via Health Professionals Online Services (HPOS) at www.servicesaustralia.gov.au/hpos or a bank account details form is available on the Services Australia website.

It is the medical practitioner’s responsibility to ensure that bank account details are up to date at all times.

BANK ACCOUNT DETAILS

Name of bank, building society or credit union

Branch where the account is held

BSB Number

Account Number (this may not be the card number)

Account held in the name(s)

Signature and Date

Please continue to next page.

http://www.servicesaustralia.gov.au/hpos

https://www.servicesaustralia.gov.au/organisations/health-professionals/forms/ip020

https://www.servicesaustralia.gov.au/organisations/health-professionals/forms/ip020

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WIP – Doctor Stream Status and Provisions Details Please indicate YES or NO for the following questions. If you are not sure of which eligibility category your work fits into, please contact your RWA.

Have you ever received a WIP – Doctor Stream (or General Practice Rural Incentives Program) payment?

Are you applying for eligible primary care services provided while working for the RFDS or an AMS? (Alternative Employment Provision)

Are you applying for eligible primary care services provided while working as a State salaried medical practitioner in MM 6-7? (Alternative Employment Provision)

Are you applying for eligible training on an approved pathway in an MM 1-2 location? (Alternative Employment Provision)

Are you undertaking GP training on an approved training pathway in an MM 3-7 location and your MBS billing did not fully reflect your services/training? (Alternative Employment Provision)

Are you applying under the Special Top-up provisions for other eligible activity completed in MM 6-7 locations on top of your other clinical services? (Special Top-Up Provision)

Please complete the activity record section on the following pages.

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ACTIVITY RECORD Please complete the activity record in the table on the following pages as required. Keep in mind you will need to cover a period of between four and eight quarters to be eligible for a payment. Please attach additional pages if required. If you would like to determine the period appropriate to your particular circumstances, please contact your RWA.

Please remember that ‘sessions’ are accumulated periods of at least three hours in an eligible location, in which a medical practitioner provides eligible services and/or undertakes eligible GP training:

Clinical Sessions

• Clinical services provided for the RFDS (GP Clinics only – not patient retrievals or transport) or an AMS (MM 3-7).

o Note RFDS GP Clinic sessions must be detailed by location and date.

• Commonwealth or state salaried medical practitioner providing primary care services (MM 6-7).

• Approved GP training in selected eligible MM 1-2 placements regardless of MBS billing levels (please include sessions in activity record and in Part 5).

• Approved GP training where MBS billing does not sufficiently reflect the services provided (MM 3-7).

Travel Sessions

• Excessive travel time to provide outreach services (MM 6-7) – refer to the WIP Guidelines for details.

Other Sessions

• Provided population health services in Aboriginal and/or Torres Strait Islander communities (MM 6-7).

• Provided support to Aboriginal and Torres Strait Islander Health Workers or Aboriginal and Torres Strait Islander Health Practitioners (MM 6-7).

A maximum of TWO sessions can be claimed per day. To claim the ‘Travel’ or ‘Other’ sessions above, you must have undertaken at least 21 clinical sessions per quarter, across all quarters.

NOTE: PLEASE RECORD ALL TIME SPENT PROVIDING ELIGIBLE WIP – DOCTOR STREAM SERVICES OR TRAINING OVER THE RELEVANT QUARTERS, REGARDLESS OF WHETHER SERVICES WERE MBS BILLED OR YOU HAVE RECEIVED A PAYMENT UNDER THE CPS.

SESSIONS MUST BE IN RELATION TO DIRECT CLINICAL ENGAGEMENT WITH A PATIENT(S).

Quarter One: July, August, September Quarter Two: October, November, December Quarter Three: January, February, March Quarter Four: April, May, June

Please note this form continues after the activity record tables.

After completing the activity record, please continue on page 19 (if you undertook GP training) or page 22.

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Please see below an example of a completed session record for Quarter 1 2019-20 (July to September 2019).

QUARTER NUMBER 1 FINANCIAL YEAR 20 19 /20 20

Placement location/Address

FPS / CPS only

Date commenced

(within Quarter)

Date ceased (within

Quarter)

Name of Employer/Practice

Number of sessions per week (eligible primary care services)

Clinical Travel

Other (special top-up)

1 Main St,

Greenville SA

5801

FPS 1/7/19 11/8/19 Greenville Medical

Centre

10 0 0

1 Main St,

Greenville SA

5801

FPS 26/8/19 1/9/19 Greenville Medical

Centre

10 0 0

2 Yellow Creek

Rd, Yellow Creek

SA, 5802

FPS 2/9/19 6/9/19

Greenville Medical

Centre (Outreach

clinic)

8 2 0

20 Smith Ave,

Orangetown, SA,

5999

CPS

only 9/9/19 30/9/19 Orangetown Clinic 8 0 0

Number of above sessions related to GP training 0

Total Number of Sessions for Quarter 106 (104 clinical + 2 travel)

Please note: In the above example, the sessions at Orangetown Clinic do not fit into the alternative employment provisions and are CPS only activity which is billed to the MBS.

CPS only activity should be recorded on an FPS application as in the above example in order to ensure that the application assessment takes all eligible activity into account.

For CPS only activity you need only provide a single entry per quarter (as activity is confirmed using service history) unlike FPS activity which requires an entry for each discrete period of work (to enable identification of periods NOT worked).

Note that sessions entered for CPS only activity will be done on a ‘date of service’ basis, however the RWA will obtain the relevant service history from Services Australia to apply to the application which will be on a ‘date of processing’ basis.

Please complete the activity record on the following pages.

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QUARTER NUMBER FINANCIAL YEAR 20 /20


FPS / CPS only

Date commenced

(within Quarter)

Date ceased (within

Quarter)



Clinical Travel


Number of above sessions related to GP training

Total Number of Sessions for Quarter



FPS / CPS only

Date commenced

(within Quarter)

Date ceased (within

Quarter)



Clinical Travel




16



FPS / CPS only

Date commenced

(within Quarter)

Date ceased (within

Quarter)



Clinical Travel






FPS / CPS only

Date commenced

(within Quarter)

Date ceased (within

Quarter)



Clinical Travel




17



FPS / CPS only

Date commenced

(within Quarter)

Date ceased (within

Quarter)



Clinical Travel






FPS / CPS only

Date commenced

(within Quarter)

Date ceased (within

Quarter)



Clinical Travel




18



FPS / CPS only

Date commenced

(within Quarter)

Date ceased (within

Quarter)



Clinical Travel






FPS / CPS only

Date commenced

(within Quarter)

Date ceased (within

Quarter)



Clinical Travel




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PART 5 – GP TRAINING CONFIRMATION If you are undertaking eligible training on an approved training pathway which falls into one of the following Alternative Employment Provisions, you will need to complete this section to have sessions related to your GP training confirmed by your Regional Training Organisation (RTO) or supervisor.

Location Alternative Employment

MM 1-2* Participants on approved training pathways undertaking approved advanced training in MM 1-2 locations regardless of their MBS billing levels.

MM 3-7 Participants on approved training pathways in eligible training placements who are not billing the MBS sufficiently to reflect the services they have provided.

* AGPT GP Registrars on the rural pathway completing relevant training placements in MM 1-2 locations (Advanced Rural Skills Training or Advanced Specialised Training) are eligible for incentives if the training is authorised by their RTO as being eligible. Eligibility of required training in MM 1-2 locations for participants on the ACRRM Independent Pathway, RVTS or PEP will be considered on a case-by-case basis in consultation with their approved supervisor, RWA and the Department of Health.

All AGPT GP registrars will need to have their session records (completed in Part 4) confirmed and signed off by their RTO in this section. Participants on the ACRRM Independent Pathway, RVTS or PEP will need to have their session records (completed in Part 4) confirmed and signed off by their approved supervisor.

Participants undertaking training who are billing the MBS for some services and meet the threshold to trigger a Central Payment System (CPS) payment, but who also have other eligible non-Medicare services to claim under the FPS, can apply for an Alternative Employment Top-Up payment.

AGPT Regional Training Organisations Name of Organisation Contact Email

Northern Territory General Practice Education (NTGPE) [email protected]

General Practice Training Queensland (GPTQ) [email protected]

Western Australian General Practice Education and Training Ltd (WAGPET) [email protected]

General Practice Training Tasmania (GPTT) [email protected]

GPSynergy (Lower Eastern NSW, Western NSW, NE NSW) [email protected]

Murray City Country Coast GP Training [email protected]

Eastern Victoria GP Training [email protected]

General Medical Training (James Cook University) [email protected]

GPEx [email protected]

Please continue to the next page.

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Session Record Confirmation

Registrar Name:

Training Pathway:

Provider Number:

REGIONAL TRAINING ORGANISATION (AGPT) OR APPROVED SUPERVISOR (ACRRM INDEPENDENT PATHWAY, RVTS or PEP) TO COMPLETE

Name of Regional Training Organisation (if applicable):

Completion and signing of this section indicates that all details recorded in Part 4 relating to GP training are true and accurate and reflected in records held.

Signature:

Print Name (RTO Officer or Approved Supervisor):

Date of Approval:

Please continue to the next page if you undertook eligible training in MM 1-2. Otherwise, continue to page 22.

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MM 1-2 PLACEMENT ELIGIBILITY CONFIRMATION If you have completed eligible training placements in MM 1-2, please complete this page. Sessions listed here should also be included in the activity record in Part 4.

QUARTER NUMBER(S) FINANCIAL YEAR

Placement location/Address Date

commenced

(in Quarter)

Date ceased

(in Quarter) Name of Employer/Practice

Number of sessions per

week


REGIONAL TRAINING ORGANISATION TO COMPLETE

Name of Regional Training Organisation (if applicable):

Signature:

Print Name:

Date of Approval:

Position/Job Title:

Copy Retained for Records: [Tick]

Reason for MM 1-2 Placement (include reference to the training pathway):

ACRRM Independent Pathway, RVTS or PEP participants who required training in an MM 1-2 location can have their approved supervisor complete this section of the form. Upon submission the RWA will consider the eligibility of this training in consultation with the Department of Health.

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PART 6 – DOCUMENTATION AND DECLARATION Supporting Documentation

All FPS Applications must be submitted with supporting documentation for each location where Alternative Employment or Special top-up services are provided.

Alternative Employment

A letter from the medical practitioner’s employer/practice manager must be submitted with ALL applications (except those relating solely to GP training). This letter must state the dates, hours and number of days that the medical practitioner practised over the relevant active quarters at each location. A standard template showing the details required is attached at the back of this form. The letter must attest that ALL sessions (except travel sessions) being claimed were solely eligible primary care services involving direct clinical engagement with a patient(s).

Only in circumstances where this is not possible will a Statutory Declaration accompanying session records be acceptable.

Special Top-Up Provisions

A letter from the medical practitioner’s employer/practice manager must be submitted with the application stating the dates the medical practitioner practised over the relevant active quarters at each location, along with brief details of the type of activity considered as falling under the Special Top-Up provisions, including the travel time. (To be included, travel time must be over three cumulative hours per week from the practice location in which the medical practitioner is based, to the location in which they are providing outreach services in MM 6-7). Please see the standard template attached showing the details required.

Only in circumstances where this is not possible will a Statutory Declaration accompanying session records be acceptable.

RFDS

In order to include travel, an RFDS medical practitioner needs to provide a covering letter from the RFDS with the following information for the relevant quarters:

1. the location and overnight location associated with each eligible session;

2. the total number of eligible sessions per week (this must not exceed a maximum of two sessions per day, including travel time).

GP Training

All practitioners undertaking eligible GP training will need to have their session records confirmed and signed by their RTO (if on AGPT) or by their approved Supervisor (if on another approved pathway) in Part 5 of this application form. For sessions which have been confirmed by an RTO/Supervisor in Part 5, an employer letter is not required.

If practitioners have undertaken eligible training in an approved MM 1-2 training placement, then this must also be recorded and signed off by their RTO or approved supervisor in Part 5.

Please continue to the next page.

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Consent to Release Information To be able to complete the eligibility assessment process and calculate payments, RWAs may need to obtain MBS service and billing history for the medical practitioner, from Services Australia. RWAs also need to provide information to Services Australia and the Department of Health for the purposes of monitoring, reviewing and evaluating the program, and to ensure any future payments to you under the CPS and the FPS are correct.

RWAs will use personal information held by them only for the purposes of administering the FPS. They are bound by the Information Privacy Principles contained in the Privacy Act 1988 to the extent that the content of those principles applies to the activities they are undertaking in administering the FPS, as if they were agencies as defined in that Act.

A condition of eligibility is that the RWA in your state or Northern Territory:

(a) has access to your data as recorded by Services Australia in order to assess your eligibility for a payment and to calculate your payment level (if appropriate); and

(b) is able to provide the information contained in your Application Form and the outcome of your application to the Australian Government Department of Health and Services Australia for the purposes of administering, monitoring and evaluating the WIP.

Note: If you choose to provide your bank account details on this form, you are permitting the relevant RWA to forward them to Services Australia to process your payment. Alternatively, you can update your bank details securely with Services Australia via Health Professionals Online Services (HPOS) at servicesaustralia.gov.au/hpos or you can supply your bank account details directly to Services Australia via the bank account details form available on the Services Australia website.

You may withdraw your consent to the collection, use and disclosure of your personal information at any time by contacting 1800 010 550. However, please be aware that if you withdraw your consent you may not be able to be provided with FPS related services or payments under the WIP.

Signed Declaration I declare that:

• The information that I have supplied in this application form is true and correct in every particular and a form for this activity period cannot be resubmitted unless requested. I understand that providing false or misleading information in this application is an offence under the Criminal Code Act 1995.

• I will advise the RWA in my state or Northern Territory within 14 days of any change in my personal details or circumstances (this cannot include changes to my Activity Record).

• I am aware that agreement to the release of information as specified above is a condition of eligibility for a payment under the FPS, and I hereby consent to the release of such information for the purposes as specified.

• I have read and understood the WIP Guidelines.

Signature

……………………………………………. Date: …..../…..../…....

The Workforce Incentive Program is subject to change or termination at any time, depending on Government policy. Payments are made on a discretionary basis and medical practitioners do not have a legally enforceable entitlement to these payments.

Please complete the checklist on the following page.

https://www.servicesaustralia.gov.au/health-professionals/services/medicare/hpos



24

PART 7 – PRE-SUBMISSION CHECKLIST

☐Have you completed all relevant parts of this form in full? Incomplete forms may delay determination of eligibility and a potential payment.

Part 5 only needs to be completed by practitioners claiming for eligible training. All other parts of the form should be completed in full. If you do not wish to provide your bank account details on this form, then you may use one of the alternative methods to provide your details to Services Australia.

☐Have you attached the supporting documentation required to justify your claim?

See the Supporting Documentation section for further information.

☐Have you signed the declaration on page 23? End of Application

See Standard Letter Template on the following page

25

[Date]

Dear Rural Workforce Agency,

I can confirm that Dr [First Name] [Last Name] has been employed at [Practice Name], located at [Practice Address], as a [Job Title] for the period of [*Insert Application Period* Day, Month, Year] to [Day, Month, Year].

[If relevant] Dr [Last Name] has been undertaking general practice training on an approved training pathway during this period.

During this time, Dr [Last Name] has provided approximately [insert number] hours over a period of [insert number] days of eligible primary care services from [this location OR list relevant locations].

I confirm that the eligible primary care services that Dr [Last Name] has provided are broadly equivalent to services from the following Medicare Benefits Schedule categories (excluding diagnostic imaging, pathology services, dentistry, optometry and bulk billing items):

• Category 1 – Professional attendances; • Category 2 – Diagnostic procedures and investigations; • Category 3 – Therapeutic procedures; and • Category 7 – Cleft lip and cleft palate.

I can confirm that all sessions being claimed for services provided at this practice (except travel sessions) are for eligible primary care services in relation to direct clinical engagement with a patient(s).

***Only include the section below if application includes a claim under the Special-Top Up provisions***

Additionally, over the period from [Day, Month, Year] to [Day, Month, Year], Dr [Last Name] undertook approximately [insert number] hours per week additional activities in the following remote or very remote locations (Modified Monash 6 or 7): [list locations], including (tick all that apply):

excessive travel time of more than three cumulative hours to provide outreach services

population health work in Aboriginal and/or Torres Strait Islander communities

support to Aboriginal and Torres Strait Islander health workers or Aboriginal and Torres Strait Islander health practitioners

Yours sincerely,

[Practice Manager or Employer Signature

Full Name

Job Title

Contact number (incl. area code)]

workforce incentive program – doctor stream …content... · there are two payment systems used...

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